Higher mortality with first line treatment of type 2 diabetes with sulfonylurea

News - Sep. 30, 2013

Association between first line monotherapy with sulfonylurea versus metformin and risk of all-cause mortality

Presented at the EASD in Barcelona by: S. Jenkins-Jones

Results of an observational study suggest that first line treatment with sulfonylureas, instead of metformin, of patients with type 2 diabetes is associated with increased risk of death.
Although guidelines do not recommend use of sulfonylureas in first line treatment, in many countries these drugs are still frequently used in this setting.

The study analysed retrospective data from the Clinical Practice Research Datalink (CPRD), a database that includes about 10% of all patients who are treated in primary care in the UK. Patients with type 2 diabetes who started first line glucose-lowering treatment between 2000 and 2012 are included in this study. Patients who received sulfonylureas (exposed) were compared with patients who were prescribed metformin (non-exposed), with regard to the primary endpoint of all-cause mortality.

After correction for differences in baseline characteristics, exposure to sulfonylureas appeared to yield a higher risk of death in comparison to people who were on metformin (adjusted HR: 1.580, 95%CI: 1.483-1.684). Comparable increased in risk were seen in two additional sensitivity analyses.

Thus, patients who received sulfonylurea monotherapy have a higher risk of death than patients who are prescribed metformin. Although this observational study did not correct for potential confounding based on indication, these results show that first line treatment with sulfonlylureas should be reconsidered.